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Date: <br /> 1. Dance and/or live entertainment. <br /> List types or permits or licenses required: <br /> 2. Alcoholic beverages. <br /> 3. Peddlers. <br /> 4. Noise abatement. <br /> 5. Other provisions as may be required: <br /> INSURANCE: Your insurance coverage must be reviewed and approved by the <br /> City's insurance carrier. <br /> 1. Public liability insurance naming City of Centerville and other public agencies <br /> additionally insured is required. <br /> 2. Hold harmless forms executed and failed. <br /> 3. List and approve /disapprove other insurance coverage as may be required. <br /> 5. FIRE DEPARTMENT <br /> Approved by: <br /> Signature Title <br /> Date: <br /> 1. Emergency vehicle access. <br /> 2. Use of fireworks, pyrotechnics, vehicle fuel, open flame. <br /> 3. Cooking facilities. <br /> 4. Occupancy and spacing of tables, enclosures. <br /> 5. Parade, floats. <br /> 6. Tents, air supported structures, canopies. <br /> 7. Other provisions as my be required by this department: <br /> 6. BUILDING DEPARTMENT <br /> Approved by: <br /> Signature Title <br /> Date: <br /> Electrical: <br /> Page 8of10 <br />